Scorecard for spina bifida research, prevention, and policy - A development process

Prev Med. 2017 Jun:99:13-20. doi: 10.1016/j.ypmed.2017.01.022. Epub 2017 Feb 9.


Spina bifida is a serious and largely preventable neural tube birth defect and an important cause of mortality and lifelong disability. The People and Organizations United for Spina Bifida and Hydrocephalus (PUSH!) Global Alliance was formed in 2014 to provide a common platform for various organizations worldwide to raise the visibility of spina bifida and hydrocephalus. In its formative phase, the alliance recognized that in order to accelerate surveillance, prevention, and care for these conditions, there was a need to provide an evidence-based assessment of how nations are performing in specific areas. In this paper, we describe the impetus for, and the process of, developing country-level scorecards for spina bifida surveillance, prevention and care. The PUSH! Executive Committee formulated a comprehensive list of six actionable indicators measuring availability of published studies on population-based folate studies; surveillance of prevalence and mortality; prevention-based policies; access to care; and quality of life associated with spina bifida. Rubrics were developed to score each country on the aforementioned indicators. Country scores were pooled across each indicator and the composite scores ranged between zero and three if there was a need for improvement, four and five if they were in good standing, or six for an excellent status. The scorecard included country-specific recommendations assimilated from the literature and published guidelines to aid policy makers in accelerating surveillance and prevention, and improving the care and quality of life indicators. For comparison, country-level scorecards were grouped by WHO-regions. Score cards were made available publicly through the website "".

Keywords: Birth defects; Congenital anomalies; Epidemiology; Evaluation; Folic acid; Global Health; Monitoring; Scorecard; Spina bifida.

MeSH terms

  • Biomedical Research*
  • Folic Acid / administration & dosage
  • Global Health
  • Health Policy*
  • Humans
  • Population Surveillance / methods
  • Quality of Life
  • Spinal Dysraphism / epidemiology
  • Spinal Dysraphism / mortality
  • Spinal Dysraphism / prevention & control*
  • Spinal Dysraphism / therapy


  • Folic Acid